Good Calories, Bad Calories

White flour and sugar were singled out as particularly noxious, because these had been increasing dramatically in Western diets during the latter half of the nineteenth century, coincident with the reported increase in cancer mortality. (They would also be implicated in the growing incidence of diabetes, as we’ll discuss, and appendicitis.) Moreover, arguments over the nutritive value and appeal of white flour and sugar had been raging since the early nineteenth century.

Flour is made by separating the outer layers of the grain, containing the fiber—the indigestible carbohydrates —and virtually all of the vitamins and protein, from the starch, which is composed of long chains of glucose molecules. White sugar is made by removing the juice containing sucrose from the surrounding cells and husk of the cane plant or sugar beet. In both cases, the more the refining, the whiter the product, and the lower the vitamin, mineral, protein, and fiber content. The same is true for white rice, which goes through a similar refining process.

This might seem obviously disadvantageous, but white flour had its proponents. It was traditionally considered “more attractive to the eye,” as Sir Stanley Davidson and Reginald Passmore observed in their textbook Human Nutrition and Dietetics (1963). It was preferred by bakers for its baking properties, and because it contains less fat than wholemeal flour it is less likely to go rancid and is more easily preserved. Millers preferred it because the leftover bran from refining rice and wheat (as with the molasses left over from refining sugar) could be sold profitably for livestock feed and industrial uses. Nutritionists also argued that white flour had better “digestibility” than whole-meal, because the presence of fiber in the latter prevented the complete digestion of any protein or carbohydrates that were attached. White flour’s low protein, vitamin, and mineral content also made it “less liable than whole meal flour to infestation by beetles and the depredation of rodents,” as Davidson and Passmore wrote.

It wasn’t until the mid-nineteenth century that white flour became suitably inexpensive for popular consumption, with the invention of roller mills for grinding the grain. Until then, only the privileged classes ate white flour, and the poor ate wholemeal. Sugar was also a luxury until the mid-nineteenth century, when sugar-beet cultivation spread throughout the civilized world. In 1874, with the removal of tariffs on sugar importation in Britain, sugar consumption skyrocketed and led to the eventual development of the biscuit, cake, chocolate, confectionery, and soft-drink industries. By the beginning of World War I, the English were already eating more than ninety pounds of sugar per capita per year—a 500-percent increase in a single century—and Americans more than eighty pounds. Not until the mid-twentieth century did mechanical rollers begin replacing hand-pounding of rice in Asian nations, so that the poor could eat polished white rice instead of brown.

Explorers would carry enormous quantities of white flour, rice, and sugar on their travels and would trade them or give them away to the natives they met along the way.^*27 In The Voyage of the Beagle, Darwin tells how the expedition’s members persuaded Aborigines in Australia to hold a dancing party with “the offer of some tubs of rice and sugar.” As early as 1892, the Barrow Eskimos were already described as having “acquired a fondness for many kinds of civilized food, especially bread of any kind, flour, sugar, and molasses.” These foods remained primary items of trade and commerce with isolated populations well into the twentieth century.^†28

Until the last few decades, the nutritional debate over the excessive refining of flour and sugar had always been about whether the benefits of digestibility and the pleasing white color outweighed any potential disadvantages of removing the protein, vitamins, and minerals. In late-nineteenth-century England, the physician Thomas Allinson, head of the Bread and Food Reform League, wrote: “The true staff of life is whole meal bread.” Allinson was among the first to suggest a relationship between refined carbohydrates and disease. “One great curse of this country,” wrote Allinson, “is constipation of the bowel which is caused in great measure by white bread. From this constipation come piles, varicose veins, headaches, miserable feelings, dullness and other ailments…. As a consequence pill factories are now an almost necessary part of the state.” Allinson’s chain of cause and effect from white bread to constipation to chronic disease was given credibility in the late 1920s by the innovative and eccentric Scottish surgeon Sir Arbuthnot Lane in a book entitled The Prevention of the Diseases Peculiar to Civilization. The hypothesis would hold a tight grasp on a school of British medical researchers for decades to come.

The preferred explanation for how sugar, white flour, and white rice might perpetrate disease emerged from a great era of nutritional research in the early twentieth century. In 1912, the Polish-born biochemist Casimir Funk coined the term “vitamine” (the “e” was later dropped) and speculated that vitamins B₁, B₂, C, and D were necessary for human health. During the next quarter-century, researchers continued to discover new vitamins essential to health and identified a host of diseases—such as beriberi, pellagra, rickets, and scurvy—as caused by specific vitamin deficiencies. Beriberi results from a deficiency in thiamine (vitamin B₁), which is lost in the refining of polished rice and white flour. This led to the suggestion that even a disease like cancer could be a kind of deficiency disease, caused by vitamin starvation, as the journalist (and future homeopath) J. Ellis Barker called it in his book Cancer: How It Is Caused, How It Can Be Prevented (1924).

The Scottish nutritionist Robert McCarrison was perhaps the leading proponent of the hypothesis that the chronic illnesses of civilization could be attributed to “the extensive use of vitamin-poor white flour and to the inordinate use of vitamin-less sugar.” McCarrison had founded a laboratory in India that would later become the National Institute of Nutrition and had spent nine years working in the Himalayas, “amongst isolated races far removed from the refinements of civilization,” as he explained in a 1921 lecture at the University of Pittsburgh. “During the period of my association with these peoples,” he wrote, “I never saw a case of asthenic dyspepsia, of gastric or duodenal ulcer, of appendicitis, of mucous colitis, or of cancer, although my operating list averaged over 400 operations a year.” McCarrison attributed their good health to several factors, including a diet of “the unsophisticated foods of Nature.” “I don’t suppose that…as much sugar is imported into their country in a year as is used in a moderately sized hotel of this city in a single day,” he said.

McCarrison’s research included a comparative study of the diets and physiques of the disparate populations and religious groups on the Indian subcontinent. The “physique of northern races of India,” McCarrison wrote, “is strikingly superior to that of the southern, eastern, and western races.” Once again, he attributed the difference to the vitamins and nutrients present in the northern-Indian diet but not elsewhere. They ate well-balanced diets, with milk, butter, vegetables, fruit, and meat—and ate their wheat ground course as wholemeal flour, which “preserves all the nutrients with which Nature has endowed it.” “White flour, when used as the staple article of diet,” wrote McCarrison, “places its users on the same level as the rice-eaters of the south and east of India. They are faced with the same problem; they start to build up their dietaries with a staple of relatively low nutritive value.” He also fed rats and mice in his laboratory on diets of these different populations and reported that the rats fared best on those diets containing “in abundance every element and complex for normal nutrition” and fared worst on those “excessively rich in carbohydrates, and deficient in suitable protein, mineral salts and vitamins.”

By World War II, this rising tide of research on essential vitamins led the United States to decree that millers had to enrich white flour with vitamin B, iron, and nicotinic acid. In England, the government acted in similar fashion a decade later. The concept of “protective foods,” containing the requisite protein, vitamins, and minerals for a healthy diet—fresh meat, fish, eggs, milk, fruits, and vegetables—now became the orthodox wisdom. During a century of debate, no one seems to have considered whether the properties of these refined foods—flour, sugar, and white rice—could have an impact on human health other than through the protein, fiber, vitamins, and minerals removed. Thirty years later, that would turn out to be the case, but by that time much of this original research on diseases of civilization would have been forgotten.